Bernards Voices

This is a very damning article. Everything said in this article is important to discuss, but I have my concerns.

Does this article make a person more or less likely to seek help from a mental health professional? Less likely.
Does this article reinforce a lay perception that MH pros are just a bunch of quacks? Yes.
Does this article increase the stigma for someone that seeks help from one of them? Yes.

I realize the author, and probably Slate’s editors, share some of my concerns, and would argue that it is the APA itself that is creating these risks, and they’re just reporting it.

But as I read the first, second, third, fourth, fifth … paragraphs it feels as if Lane is driving nails into the coffin of something we shouldn’t kill.  Do you hear the nail splinter the pine box with each hammer strike?  I’d like him to be a little more relenting, create a little less collateral damage.

Ok, I’ve said my peace. Now the article in Lane’s own words.

The American Psychiatric Association has no clear definition of the cutoff between normal and pathological responses to life’s letdowns.

The association risks losing sight of that distinction by grimly—and rather inexpertly—debating whether avid shopping should be considered a sign of mental illness. The fifth edition of the association’s Diagnostic and Statistical Manual of Mental Disorders is expected in 2012. The APA isn’t just deciding the fate of shopaholics; it’s also debating whether overuse of the Internet, “excessive” sexual activity, apathy, and even prolonged bitterness should be viewed, quite seriously, as brain “disorders.”

Allen Frances chaired the DSM-IV task force. Robert Spitzer editted DSM-III and -IV.

After Frances made his objections public last month, he and Spitzer followed up by sending the APA an open letter: “Unless you quickly improve the internal APA DSM-V review process, there will inevitably be increasing criticism from the outside. Such public controversy will raise questions regarding the legitimacy of the APA’s continued role in producing subsequent DSMs—a result we would all like to avoid.”

Spitzer and Frances also strongly disagree with a proposal to include “subthreshold” and “premorbid” diagnoses in the new manual. Both terms give cover to the so-called “kindling” theory of mental illness in children and infants—some psychiatrists believe that it’s possible to stamp out ailments before they burgeon into full-blown disorders.

This idea of kindling relates to my post yesterday on catching schizophrenia during prodrome before it turns psychotic.

In practice, as the St. Petersburg Times reported in March, psychiatrists in Florida alone gave antipsychotic drugs off-label (without formal FDA approval) in 2007 to 23 infants who were less than 1 year old at the time. They extended the practice to 39 toddlers aged 1; 103 aged 2; 315 aged 3; 886 aged 4; and 1,801 aged 5. One shudders to think what is going on in other states.

If you’re still reading down here at the bottom of the post, you may be wondering what is the DSM for. Here is wikipedia:

Many mental health professionals use this book to determine and help communicate a patient’s diagnosis after an evaluation; hospitals, clinics, and insurance companies also generally require a ‘five axis’ DSM diagnosis of all the patients treated. The DSM can be used to establish a diagnosis or categorize patients using diagnostic criteria. The DSM may also be used in mental health research. Studies done on specific diseases often recruit patients whose symptoms match the criteria listed in the DSM for that disease.

The wrong coding in the DSM may excuse your insurance company from paying.

On Sunday, this article was posted on MSNBC.  It mentions Robert Wood Johnson funds which reminds me of this post from Lauren.

I read an article like this completely differently than I would have a few years ago.  This idea that psychosis is a distinct phase in some illnesses like schizophrenia and manic-depression was news to me. And that mental illness is a progressive disease.  I thought back then that crazy just meant crazy. (I don’t know if it is true for schizophrenia, but Kramer in his book Against Depression, demonstrates that depression, untreated, deepens over time and becomes more frequent.)

I’m then very keen on what are the early warning signs that hint that psychosis is coming.

Then I look for the bottom line … does the new treatment or program have proven results?  In this case not yet, but the article gives anecdotal evidence that PIER is helpful.

Subtle, early signs
Researchers have known about this warning phase [or prodrome] for decades, but they’re still working on how to treat it. Now they’re calling in tools like brain scans, DNA studies and hormone research to dig into its biology. They hope that will reveal new ways to detect who’s on the road to psychosis and to stop that progression.

In the prodrome, people can see and hear imaginary things or have odd thoughts. But significantly, they understand these experiences are just illusions, or they have a reasonable explanation. In contrast, people with psychosis firmly cling to unreasonable explanations instead.

PIER emphasizes non-drug therapies for its patients, ages 12 to 25, although about three-quarters of them take anti-psychotic medication.

The treatment regimen includes group meetings in which patients and families brainstorm about handling the condition’s day-to-day stresses. It also focuses on keeping patients in school and in touch with their families and social networks.

With a grant from the Robert Wood Johnson Foundation, the PIER approach is also being tried in California, Oregon, Michigan and New York.

When it comes to treating the prodrome, scientists say they have some promising approaches but no firmly proven treatments to prevent psychosis from appearing.

Leonard Lopate interviews Buzz Aldrin about his memoir.

Aldrin sprinkles in ideas from time to time about depression, anxiety, alcoholism throughout the interview. It is all worth listening to.

What were Aldrin’s first words responding to questions about his depression?
“I was part of a structure.” After he walked on the moon, the purpose and structure evaporated.

“getting the brass ring”
“maybe in the eyes of some … undeservedly”
“highly competitive environment” “prima donna, ego, society”

Stories about NASA and astronauts always draw me in.  I grew up in Nassau Bay across from NASA Johson Space Center in Houston, Texas. My dad worked there as a chemical engineer.  My sisters babysat for kids when their dads were on missions.  Some of my friends had dads in space.  Tour buses circled the neighborhood from time to time.  I was interviewed by a Frenchnewspaper woman when I was 8 years old during the Apollo11 mission.

Nathan Rabin, an editor at the Onion, talks about finding rescue in pop culture.

He talks directly about being “tremendously ashamed” and “guilt-ridden” as a child.
Was hospitalized, went thru foster care …

Why did he write his memoir, The Big Rewind?
He wanted to “own his life story and not have it own” him.
Pop culture gave Rabin the tools “to fight depression.”

Having listened to podcast, and not having read the book, my interpretation of the pop culture rescue is: 1st just the pure entertainment, distracting from the internal rumination, etc. 2nd, he sees he is not alone. And maybe 3rd, finding a purpose/goal. But we can’t understate the importance of finding the right anti-depressants.

The article below was the basis for a letter published in the Bernardsville News on July 23, 2009.

To see the plan map and detailed description in separate windows click on map and description. Suggestion: Maximize each window and then toggle between them. The description contains six pages. For a table of contents click index.

It’s a balmy mid-summer day as I write this for residents of Bernards Township.  And I’m thinking that I would like to be in, or on, or just looking out over a nice lake. Today we have to drive many miles for this opportunity. But with imagination, and the will to achieve what we imagine, we can have a large lake for our use and enjoyment right here in Bernards Township.

The place is now the Tilcon Millington Quarry and the time–when the lake will be full and available for fishing, boating, swimming, and other things–will be about 2020. The lake will be inside what I call Quarry Park. The park will contain 100 plus acres and will have facilities for active and passive recreation, such as trails for walking and biking, a put-in ramp for non-motorized boats, and a slope for snow sports. Operations for a bathing beach will be financially self-supporting like Pleasant Valley Pool.

A detailed concept plan is described in a letter to the Planning Board dated July 17, 2009. This is a slightly revised version of a plan first submitted to the board on August 17, 2004.

The board is currently engaged in a review of the township master plan. I intend to present the park plan to the board during a period for public comment. The plan is presented here in two parts: a drawing of a map and a description of the map. To view them in separate windows click on map and description.

The map includes a private community of townhouses on the south slope that is surrounded on three sides by the public park. I call this Lakeview Village.

The wrapup for the letter to the Planning Board contains these comments:

• The park with lake and adjacent land will serve the general public and support many kinds of active and passive recreation.
• The lake will be part of the public park and be managed by the township. This will remove the uncertainties associated with management by a private association.
• The park will be a valuable amenity for the residents of Lakeview Village. The Village will probably become the premier townhouse community in the township.
• The fiscal impact of the substitution of townhouse units for single family units will be positive, because the property tax revenue for each public school student will be higher.
• This can be a case of win-win for the quarry owner and for township residents.

Bernards Residents: You can have this park if you tell your township officials you want it.  Start by attending and speaking at the Planning Board public hearings on the master plan.  Then speak to members of the Township Committee.

Bill Allen,    July 17, 2009

I’m attaching a very interesting article from a recent issue of TIME magazine that focused on health care, with the emphasis of prevention.  This piece is about research that’s been done on preventing or minimizing the onset of serious mental illness among high risk youngsters by using a family intervention and support approach.

I highlighted a couple of paragraphs of special interest, last but not least, the one that states that the Robert Wood Johnson Foundation has earmarked significant funds to support a nationwide expansion of the program.

In any given year, approximately 17% of Americans under 25 have a mental, emotional or behavioral disorder. (Over our lifetime, 46% of us will receive such a diagnosis.) If we reduce the proportion of young people who become mentally ill by even one-quarter, that would mean about 3.8 million saved each year from what can turn into a lifelong struggle.

How long is the window between first symptoms and actual diagnosis? The National Academies report says that across several mental illnesses — including obsessive-compulsive disorder, depression and substance dependence — we have about two to three years to intervene and keep short-term symptoms from becoming long-term afflictions.

One Family at a Time. The Robert Wood Johnson foundation is so impressed with McFarlane’s program that it has devoted $15 million to its national expansion. It is the foundation’s single largest mental-health initiative.

Does anyone on the steering committee have contacts there? It would be interesting to find out a little more and to learn whether there are any grant/funding opportunities related to it.

The Bernards Planning Board is currently engaged in a review [aka "reexamination"] of the township master plan.  This task is undertaken every six years and is mandated by state law.  Working meetings are held at Town Hall on the last Wednesday of each month.  Members of the public may observe and there is opportunity for public comment.

“Land Use” is the principal element in the master plan,  The review must include the goals, objectives, and recommendations for land use throughout the township, and this includes residential development.

Bernards currently has many kinds of houses that serve many kinds of households.  However, current regulations restrict new residential development to single family units.  Statewide data over decades has shown that single family units in the aggragate tend to produce fiscal losses, and multifamily units in the aggragate tend to produce fiscal profits.  Extensive data show that we have this condition in Bernards.

There is a simple explanation:  Single family units in Bernards are on average home to four times as many public school students as multifamily units.  The average tax revenue produced for each student from a single family unit is about half the revenue produced for each student from a multifamily unit.     

I propose that the township development regulations be revised to allow the substitution of two townhouse units for each single family unit that is allowed under current zoning, in those locations where there will be no adverse impact on nearby property owners.

In addition to the fiscal benefit, townhouses use and disturb less land.  This is particularly relevant for the future of the quarry land.  A townhouse development on the relatively unsteep south slope will allow the lake and surrounding land to be used for a public park.

I have submitted two letters to the Planning Board supporting this proposal and made a brief presentation to the board on June 24.  To read the letters click on June 17 letter and June 25 letter. 

Bill Allen,  July 10, 2009 and July 27, 2009